Occupational health and safety hazards at the scenes were assessed in a variety of ways, according to conference participants. A primary method was direct observation, backed by personal experience: "First responders know the typical hazards," said one panelist.

Hazard assessment
Such immediate assessments were supplemented by more formal and detailed hazard monitoring. Conference participants noted that there were many people, representing many different organizations engaged in monitoring, at the attack scenes. In some cases, the large number of agencies involved led to confusion--over who was authorized to engage in monitoring, what the appropriate monitoring standards were, and what the proper thresholds were. Another problem panelists reported was that data gathered were contradictory because each person and organization brought a different approach to hazard assessment and management. "Nobody agrees what is safe," noted a special-operations panelist, who also noted the lack of agreement about what the appropriate response should be. "There is no cookbook," said another. According to special-operations personnel, problems with uncoordinated hazard assessment also existed at the Oklahoma City site.

Shawn Moore/OSHA News Photo

OSHA compliance officers survey the World Trade Center recovery site to identify hazards and recommend corrections. OSHA provides around-the-clock monitoring of the site to identify and alert workers to safety and health hazards.

Risk communication
Emergency responders repeatedly stressed the importance of having timely health and safety information. "Responders respond and they go to work right away, with or without information," stated a special-operations panelist. "What kills rescue responders is the unknown," commented an emergency medical services (EMS) panel member. "If you had the known, you should be hopefully prepared for it." The information must also be accurate, as one law-enforcement panelist warned: "With cops, it's a real simple mantra: 'If you don't give me information, I will give you a rumor.' And rumors will spread faster than information." Although many organizations and agencies were actively monitoring health and safety hazards at the terrorist-incident sites, problems in producing and disseminating hazard information reduced the effectiveness of their efforts.

	Information & Communication
	Shawn Moore/OSHA News Photo
	For many conference participants, a lack of information on hazards was not a problem. Rather, many spoke of difficulties trying to manage and make sense of a surplus of information.

Risk communication varied among the terrorist-attack sites. It reportedly took a week before coordinated daily briefings on the conditions at the World Trade Center site were conducted. Eventually, risk and hazard information was communicated to agency and team leaders through on-site daily meetings. At the World Trade Center and Pentagon sites, several different daily meetings were held covering issues such as safety and health, incident planning, and daily goals and activities. In addition, some agencies produced periodic "situation reports" for their staffs. At the same time, there was a sense among some panelists that the information often failed to get communicated to individual front-line responders or "across a number of organizations."

Several additional shortcomings were noted by conference participants. Special- operations and law-enforcement responders reported the problem of different information sources telling them different things. One participant related the following anecdote: A computer bank with a large backup battery power unit was located within the fire zone at the Pentagon. Initial guidance provided by Urban Search and Rescue (USAR) teams indicated that the batteries did not present a significant hazard, and responders had been working in and around them for 12 to 14 hours. Subsequent consultations with the private contractor engaged in the building's renovation indicated that the batteries should be treated as a hazard: "We isolated that area and didn't go in there." Speaking of the World Trade Center, another special-operations responder pointed to a series of waves of concerns, including fear of radioactivity: "We went from 'There is asbestos' to 'There isn't asbestos,' to 'There is this,' 'There isn't that,' and the levels of protection changed."

Such information conflicts often were attributed to differences in risk assessment and personal protective equipment (PPE) standards among reporting parties. In other instances, they were attributed to organizational turf battles and personal conflicts. One responder described a safety meeting where specialists from different agencies at the front of the room began arguing with one another, and as a result, the meeting did not resolve anything.

Some responders who received information on hazards that were not consistent with their personal observations stopped trusting all the information they received from monitoring organizations. "One of the first [reports] . . . said that all of the stuff at the World Trade Center was within normal limits. Now, a lot of that is how you deliver that message, because there was nothing normal about the stuff," said an EMS responder.

	The Anthrax Incidents
	FBI File Photo
	High levels of uncertainty surrounded the responses to the anthrax episodes in autumn 2001, making the appropriate personal protection strategies difficult to execute.

Especially in the case of anthrax, keeping up with changing information being provided by numerous agencies was a serious challenge for front-line responder organizations. The desire to have accurate information was of particular concern to commanders, who were making decisions about what level of risk their personnel would face. "You've got to understand what you're dealing with," said a law-enforcement representative. "We can equip our first responders to a certain level . . . but as managers, we have to understand what risks they are capable of dealing with or what hazards [are out there], and we have to weigh what roles they can play." Another said, "If we put them in the wrong outfit and something happens to them, then we're going to get sued. I'm going to get sued personally, perhaps."

Finally, an EMS panel member observed that post-event information can be just as important: Sometimes responders were not told whether the test on the suspicious substance they responded to turned out to be positive for anthrax or not. The responder assumed that they would have been informed if it was positive, but the lack of certainty caused stress anyway.

Personal protective equipment training and information
The responses to the terrorist attacks uncovered a range of PPE training and information needs. Before an incident occurs, those who are likely to be involved in a response should be trained on the proper selection and operation of personal protective equipment. Emergency medical technicians who were themselves treating casualties in the heart of the disaster site should have been wearing PPE but frequently were not, in large part because this equipment was not part of their standard training regimen.

The experiences in these incidents also showed that there is a need for significant on-site training to protect the health and safety of workers. The attack sites involved large numbers of workers, particularly construction workers and volunteers, many of whom were not familiar with most PPE. They needed to be trained in the proper selection and fitting of respirators, how to maintain them, and when to change filters. The situation with anthrax was more severe. Health and safety panel members felt that training support during the anthrax attacks was inadequate on all fronts: The response protocols were being developed during the actual responses.

FEMA News Photo Oklahoma City, OK, April 26, 1995 -- Search and rescue team survey the bomb-damaged Murrah building.

FEMA News Photo Search and rescue teams survey the bomb-damaged Murrah building.

Emergency responders repeatedly stressed the importance of having timely and reliable health and safety information. "What kills rescue responders is the unknown," commented an EMS panel member. Several shortcomings were noted by conference participants. Special-operations and law-enforcement responders reported problems caused by different information sources telling them different things. Such information conflicts were often attributed to differences in risk assessment and PPE standards among reporting parties. Especially in the case of the anthrax incidents, keeping up with changing information being provided by numerous agencies was a serious challenge for front-line responder organizations. For many conference participants, the problem was not a lack of information on hazards. Rather, they spoke of difficulties trying to manage and make sense of a surplus of information. Finally, conference attendees suggested that better and more consistent information provision could motivate responders to wear PPE and could decrease the tendency to modify it or take it off when it becomes uncomfortable.

Site Management
One message that emerged clearly from virtually all panel discussions is that proper site management had a decisive effect on whether personal protective equipment was available, appropriately prescribed, used, and maintained.

The most critical need for site management is a coherent command authority. An effective command structure is essential to begin solving three critical issues affecting PPE: information provision, equipment logistics, and enforcement. Due to logistical problems early in the response, for example, supplies of PPE were misplaced, the stocks of equipment that were available were largely unknown, and responders often did not receive or could not find the equipment they needed.

Andrea Booher/FEMA News Photo

New York, NY, October 5, 2001--Rescue workers continue their efforts at the World Trade Center.

Conference attendees also emphasized the need for immediate and effective perimeter or scene control. Initially, this entailed responders personally "holding people back" and isolating the scene. As the response evolved, it was necessary to erect a "hard perimeter," such as a chain-link fence, to make sure only essential personnel operating under the direction of the scene commander were on-site.

Conference attendees also indicated that enforcement of PPE use is very important. Although panelists acknowledged that there is a period early in a chaotic response when it is not practical to rigorously enforce the use of protective equipment, they indicated that strict enforcement must eventually begin in order to protect the health of the responders. Other factors that complicated enforcement of PPE use were the large number of organizations (with different PPE standards) operating on-site, the lack of a unified command, and short-comings in scene control. Because of the difficulty of defining when it is appropriate to begin enforcing PPE use--and removing workers from the site if they do not comply with use requirements--attendees indicated that this role might be best played by an organization not directly involved in or affected by the incident.